Understanding Non-small Cell Lung Cancer

Of the two main types of lung cancer, small cell and non-small cell lung cancer, the most common type is non-small cell lung cancer (NSCLC). About 85% of lung cancers are NSCLC.1 NSCLC is characterized by its subtypes, known as histologies. Histology describes the specific kind of cancer cells that have been found in your NSCLC.

What Are the Risk Factors for Non-small Cell Lung Cancer?

There are several risk factors for NSCLC. Simply having one or a few of these risk factors does not mean that you will get lung cancer. You should consult with your healthcare team and evaluate your own risk for lung cancer.

Below are some of the risk factors for lung cancer2:

  • Stopping smoking at any age may lower the risk of lung cancer.

    This is because when you stop smoking, the damaged cells in the lung can repair themselves.

    Smoking
    This is the leading risk factor for lung cancer. Tobacco smoke, which contains chemicals that are known carcinogens, causes 8 out of 10 cases of lung cancer. The risk for lung cancer increases the longer someone has smoked and the more packs per day they have smoked.

    Lung cancer can also develop in people who are themselves not smokers, but who breathe in the smoke of others (also called secondhand smoke). Non-smokers who live with a smoker or who are exposed to tobacco smoke in the workplace are at risk for lung cancer

    It is estimated that nonsmokers who are exposed to secondhand smoke at home or work increase their lung cancer risk by 20-30%3

  • Air pollution
    Pollutants in the air may increase a person's risk of lung cancer slightly. It is estimated that about 5% of all deaths from lung cancer worldwide are related to air pollution. However, the risk of lung cancer due to air pollution is still far less than that of smoking
  • Radon
    Radon is a radioactive gas that you cannot see, smell, or taste. It forms in soil and rocks. Radon damages lung cells, and those who have been exposed to radon in higher quantities, such as miners,4 are at increased risk for lung cancer. Radon can also build up indoors and increase the risk of lung cancer.

    To learn more about radon and testing for it in your home, click here

  • Asbestos and other substances
    People who work with asbestos have a higher risk of getting lung cancer
  • Other cancer-causing agents in the workplace
    There are things in some workplaces that can increase the risk of lung cancer. Examples include:
    • Radioactive ores, such as uranium
    • Harmful inhaled chemicals
    • Diesel exhaust
  • Personal or family history of lung cancer
    Brothers, sisters, and children of people who have had lung cancer may have a slightly higher risk of getting lung cancer
  • Certain vitamins
    Certain vitamins (such as beta carotene) have been shown to increase the risk of lung cancer in smokers
  • DNA and gene changes
    Some risk factors may cause certain changes in the DNA of lung cells, causing them to become cancerous

Back to top of section

Diagnosing Non-small Cell Lung Cancer

Many people with lung cancer have no symptoms until much later in the progression of their disease. Only about 15% of cancers are discovered in the earliest stages.5

However, if you think that you have risk factors for lung cancer because of your smoking history, occupation, or family health history, discuss this with your healthcare team and ask about screening options.

The following tests may be used by your healthcare team to determine if you have lung cancer and, if you do, how far along it has progressed6:

  • Physical exam and history
    This is an exam of the body to check general signs of health, including checking for signs of disease, such as lumps that seem unusual. A history of your health habits and past jobs, illnesses, and treatments will also be reviewed
  • Laboratory tests
    These are procedures that test samples of tissue, blood, urine, or other contents in your body. These tests may help to diagnose disease, plan and check treatment, or monitor the disease over time
  • Chest x-ray
    This is an x-ray of the organs and bones inside the chest. This may help to detect tumors
  • CT scan (x-ray computed tomography, or CAT scan)
    This is a procedure that makes a series of detailed pictures of areas inside the body, such as the chest, taken from different angles. The pictures are made by a computer connected to an x-ray machine
  • Sputum cytology
    This is a procedure in which a pathologist views a sample of sputum (mucus coughed up from the lungs) under a microscope to check for cancer cells
  • Fine-needle aspiration (FNA) biopsy of the lung
    This is a procedure in which a sample of tissue or fluid is removed from the lung using a thin needle and sent to a laboratory, where a pathologist then evaluates the sample to look for cancer cells
  • Bronchoscopy
    This is a procedure in which the inside of your lung is examined for abnormal areas using a bronchoscope
  • Thoracoscopy
    This is a surgical procedure that looks at the organs inside the chest to check for abnormal areas. A cut is made between two ribs and a thoracoscope is inserted into the chest for viewing
  • Thoracentesis
    This is the removal of fluid from the chest cavity outside the lungs using a needle. A pathologist views the fluid under a microscope to look for cancer cells
  • Light and electron microscopy
    This is a laboratory test in which cells in a sample of tissue are viewed under highly specialized and powerful microscopes to look for abnormalities
  • Immunohistochemistry study
    This is a laboratory test in which a sample of cancer tissue is treated with chemicals in order to determine the specific type of cancer

Back to top of section

When It Comes to Your Lung Cancer and ALIMTA, Histology Matters

Research has shown that there is a link between histology and the effectiveness of ALIMTA® (pemetrexed for injection) in NSCLC.

ALIMTA can suppress bone marrow function, which may cause low blood cell counts.

There are 3 main histological subtypes found in NSCLC.1

Adenocarcinoma:

Adenocarcinoma
Images Copyright © 2007 Asterand PLC

About 40% of lung cancers are adenocarcinomas. This type of lung cancer is found mainly in people who smoke or have smoked at some point in their lives; however, it may also occur in people who have not smoked. It is more common in women than in men, and in younger people.

Squamous cell carcinoma:

Squamous cell carcinoma
Images Copyright © 2007 Asterand PLC

About 25% to 30% of all lung cancers are squamous cell carcinomas. They are often associated with a history of smoking.

ALIMTA is not indicated for patients who have squamous cell NSCLC.

Large cell carcinoma:

Large cell carcinoma
Images Copyright © 2007 Asterand PLC

This type of cancer accounts for about 10% to 15% of lung cancers. It tends to grow and spread quickly.

There are also less common forms of NSCLC, such as adenosquamous carcinoma and sarcomatoid carcinoma.

Do you have questions about your lung cancer? Use the Questions for Your Doctor tool to help get your questions answered at your next doctor's appointment. If you do not know your type or subtype of lung cancer, be sure to talk to your healthcare team.

Back to top of section

Factors Affecting Your Prognosis

Take an Active Role in Your Treatment

Research your treatment options and ask your healthcare team which treatment is best for you. You may find it helpful to understand why a specific treatment was chosen for you.

The prognosis and treatment options for people with NSCLC depend upon the following6:

  • The stage of the cancer when it is found. This is determined by the size of the tumor and whether it is in the lung only or has spread to other places in the body
  • Your type of lung cancer, which includes the histology of the NSCLC
  • Whether there are symptoms such as coughing or trouble breathing
  • Your general health

Back to top of section

References:
  1. American Cancer Society. What Is Non-small Cell Lung Cancer? Available at: http://www.cancer.org/Cancer/LungCancer-Non-SmallCell/DetailedGuide/non-small-cell-lung-cancer-what-is-non-small-cell-lung-cancer. Accessed December 7, 2012.
  2. American Cancer Society. What Are the Risk Factors for Non-small Cell Lung Cancer? Available at: http://www.cancer.org/Cancer/LungCancer-Non-SmallCell/OverviewGuide/lung-cancer-non-small-cell-overview-what-causes. Accessed December 7, 2012.
  3. Office of the Surgeon General. The Health Consequences of Involuntary Exposure to Tobacco Smoke. Available at: http://www.surgeongeneral.gov/library/reports/secondhandsmoke/. Accessed December 7, 2012.
  4. American Cancer Society. Radon. Available at: http://www.cancer.org/Cancer/CancerCauses/OtherCarcinogens/Pollution/radon. Accessed December 7, 2012.
  5. CancerCare: Screening & Early Detection. Available at: http://www.lungcancer.org/reading/screening.php. Accessed December 7, 2012.
  6. National Cancer Institute. General Information About Non-small Cell Lung Cancer. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/Patient/page1. Accessed December 7, 2012.

ALIMTA Indications

ALIMTA is approved by the FDA in combination with cisplatin (another chemotherapy drug) for the initial treatment of advanced nonsquamous non-small cell lung cancer (NSCLC), a specific type of NSCLC. ALIMTA is not indicated for patients who have a different type of NSCLC called squamous cell.

ALIMTA is approved by the FDA for the treatment of patients with advanced nonsquamous non-small cell lung cancer (NSCLC), a specific type of NSCLC, to maintain the effect of initial treatment with chemotherapy and whose disease has not worsened. ALIMTA is not indicated for patients who have a different type of NSCLC called squamous cell.

ALIMTA is approved by the FDA as a single agent (used alone) for the treatment of patients with advanced nonsquamous non-small cell lung cancer (NSCLC), a specific type of NSCLC, after prior chemotherapy. ALIMTA is not indicated for patients who have a different type of NSCLC called squamous cell.

ALIMTA is a treatment for malignant pleural mesothelioma (MPM), which is a cancer that affects the inside lining of the chest cavity. ALIMTA is given with cisplatin, another anticancer medicine (chemotherapy), when surgery is not an option.

ALIMTA can suppress bone marrow function, which may cause low blood cell counts.